The Webinar Gazette The Webinar vet
To provide: The highest quality vet-led content To be: The world’s largest online veterinary community
may 2019
To have: The planet’s most confident vets
WHAT’S INSIDE Hot News AC’s Intro News from our community CPDer of the month Speaker of the month JHP Recruitment Job Board StreetVet Jane’s Blog David’s reviews From the Literature
HOT NEWS Would you prescribe cannabis to a dog?
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t may well be a question you’ve never really asked yourself. For a start, it’s illegal, so it’s been a moot point anyway. As the law currently stands, vets can be struck off for even discussing the issue with a client. However, in California, that could soon change. A new bill has been introduced into the weed-friendly state that would allow vets to recommend medicinal cannabis if they think it’s appropriate. California has allowed the use of medical cannabis for humans since 1996, and permitted the use of recreational marijuana since 2016, which has led to some people now questioning why it’s still prohibited to utilise it for veterinary medicine. Attitudes towards cannabis tend to be split into two camps: the conservative view that it’s one of those “bad” drugs which leads to moral decay in society, and the stoner culture that promotes
getting high as a kite and doing nothing except watching cartoons all day without blinking and periodically muttering “whoa, dude”. Innumerate comedy films have entrenched this dichotomy about cannabis’ place in society, as a group of counterculture hippies versus The Man. Very little space is left for the position in between, that its use can benefit society. What this means is that any attempts to sincerely discuss the place of medical cannabis in veterinary almost immediately gets derailed by jokes about dogs getting stoned, which may be funny but is ultimately unhelpful. Broad polls of veterinary professionals have shown that vets tend to skew towards the conservative end of the political spectrum, which might also mean reluctance to embrace something seen as such a quintessentially liberal point of view. Vets tend to see things as “science” and “not science”, and where that line is drawn can be rather
arbitrary. Completely dismissing anything for which there is less than a 100% scientific consensus can mean that we close our minds off to the grey areas where things overlap. A good example of this recently is Mindfulness – people had been practicing variations of this stress reduction technique for over 5,000 years, and it’s been known to work, but we rejected centuries of received wisdom until we could find the scientific proof that it works. Consider other anomalies like the placebo effect – by its very nature, the placebo effect shouldn’t work, scientifically speaking. The idea that your mind can heal your body with positive thoughts seems so far from science as to be laughable – yet, it happens. Cannabis gets lumped into this category of junk science and popular culture progressive talking points, and it becomes very easy to dismiss the whole thing. This is unfortunate, because when you actually examine the evidence,
I there is a lot of reason to believe that cannabis does have genuine medicinal properties, and that a lot of people are being denied access to a useful chemical compound because of subjective social perspectives. In fact, medical cannabis has been shown to have success treating several serious conditions in humans, including autoimmune disorders, neurological disease, inflammation, kidney disease, and even cancer – yes, peer-reviewed studies have found that a cannabis compound can stop the growth of various cancer cell types. It’s not just stoners trying to justify their lifestyle. The science is there. (However, it should be made clear that just smoking weed all day isn’t going to keep you healthy, and probably will contribute to lung disease in the long run. The universe isn’t that kind). So, to come back to the original question; would you start prescribing cannabis to animals? Are we missing a trick here? Concerning veterinary medicine specifically, the truth is that right now the research just hasn’t been done. However, anecdotal evidence suggests that medicinal cannabis is effective in controlling shaker dog syndrome, eases joint pain, and improves kidney function in the case of kidney disease. A professor of veterinary neurology and neurosurgery in Colorado State University has been conducting studies into CBD treatments for anxiety relief, appetite stimulation and reductions in the side effects of cancer treatment, with positive results. There are several unaccredited organisations that promote the idea of expanding medical cannabis to the veterinary world, although it’s unclear exactly who runs these organisations or how credible they are. Generally speaking, we just don’t know enough to roll it out right now. But it certainly seems like it could warrant investigation.
was at a Michael Ball concert recently at the Liverpool Empire with my wife and mother-in-law. There’s a guy who loves what he does and has a legion of adoring fans! Michael sang a beautiful song called “Anthem” from the musical ‘Chess’, written by Benny and Bjorn from Abba. My wife got quite emotional because of the ending verse from the song; “ Let men’s petty nations tear themselves apart, my land’s only borders lie around my heart.” Both of us reflected on the ongoing woes currently sweeping the nation and indeed the globe. At Easter, the message is that we solve problems by loving each other and by giving, not taking. I’m keen to always be a voice of positivity in a world where the negative story can hog the headlines. This month, we are launching our third mindfulness series with Mike Scanlan. Mike’s had a rough year. He received serious injuries whilst attempting Land’s End- John O’ Groats on his bike but he is now back with another series to help us cope with everyday life. The last two series have been amazing, the testimonials from vets and nurses expressing their thanks for the webinars has been truly heart-warming.
Members get free access as part of their membership- yet another reason to try membership if you haven’t. This is also a fabulous series to offer other members of your team whether they work in a pharma firm like Protexinor are a receptionist in a busy practice. I’ve been privileged to watch Liverpool in the Premier and Champions League this year. The league has been nip-andtuck between Liverpool and Man City, whilst Liverpool will play the mighty Barcelona very soon. Whatever happens, Jurgen Klopp has moulded a happy team. He is an inspirational leader and I’ve been watching him closely tips for my own business. His focus and his positive attitude encourage me to copy him - it’s always good to look outside the profession for inspiration. It’s how I came up with the idea for The Webinar Vet.
Wishing you peace and joy in this Easter season!
Anthony
NEWS FROM OUR COMMUNITY
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t’s always nice to see a member’s business grow, and we’ve been following along as Lanes Vets build their newest branch in Cottam! They’ve been sharing construction updates on their Facebook page and we can’t wait to see the finished product! You can find out more about Lanes Vets and follow along with their progress here: https://www. facebook.com/lanesvets
CPD’er of the month Our CPDer of the month this month is Cornel Igna, who racked up an astonishing 85 hours of CPD over the course of one month! This is an amazing achievement and commitment to furthering his understanding and knowledge. Here’s what Cornel said about his achievement and our service to help him continue to grow.
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Webinar Vet is for me: • The most complete and up-to-date source of documentation discovered by me after 35 years of my teaching career and as a practitioner surgeon – a
BRILLIANT idea; The possibility to compare levels of training (e.g.: United Kingdom vs Romania) and to complete and update my information in the field; The opportunity to hear recognised professors in my field of work (e.g.: Innes, Whitelock, Allen, Carmichael, Hall, Berg); The joy of seeing approaches and work methods of other colleagues; Improving the way of education; The best way to keep you informed; When you discover over 900 topics, you can’t wait to jump in and start watching! It helps me develop myself and inspires me in my job of educating students
A special mention also goes to Kim Bussell of Hafren Vets, who completed an amazing 50 hours of CPD in one month, so we felt that this achievement shouldn’t go unmentioned! We hope that all of our community are getting as much value from our service as Cornel and Kim.
Speaker of the month Alenka Hrovat Vernik
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lenka graduated from the University of Ljubljana in 2002. She then went on to complete a PhD in Biomedicine at the same University in 2009. Upon completion of her PhD she undertook internal medicine residency at Ghent university and was awarded her European Specialist Diploma in 2017 and RCVS Specialist status in 2018. Alenka has worked at a number of referral hospitals (Eastcott Referral Hospital, Langford Vets, Southfields Veterinary Specialists and North Downs Specialist Referrals) before joining Pride Veterinary Centre in August 2018. She held several CPDs on various topics in small animal internal medicine in UK and Europe. She authored and co-authored several original papers in peer reviewed veterinary and biomedicine journals and textbooks, and presented her work at European and US congresses. She is interested in all areas of small animal internal medicine.
What’s your favourite thing to do of a weekend? Spending time with my daughter, cooking and eating lots of delicious food. What area do you specialise in? I am a good internal medicine all rounder and intend to keep it this way! Why did you choose this career path? Because I love animals! (as corny as it sounds). What do you enjoy most about your job? Moments when my patients are sent home and they go completely bonkers with happiness when they are reunited with their owners. What are some everyday challenges you face in your profession? Management of expectations from clients, colleagues and other professionals. If you weren’t doing this career, what do you think you would be doing instead?
Tell us a bit about yourself‌
Paediatrics - human medicine.
Not much to say except I am lucky to be in this profession.
Are you on social media and happy for people to connect with you? If so, what are your contact details?
What’s your favourite holiday destination? I love Italy and Croatia, and Slovenia for skiing.
Not on social media (I swear!) đ&#x;˜Š
JHP Recruitment Job Board Full Time – Permanent – Veterinary Surgeon – Hampshire – Ref 11295 JHP’s client are looking for a full-time Veterinary surgeon to join them in their fantastic, modern and well-equipped practice in Hampshire. This is a 40-hour working week. You will also be part of our weekend rota too, working 1 in every 4 weekends. The client can provide a fantastic salary package along with CPD, RCVS fees and much more. Click to find out more: http://www.jhprecruitment-veterinary. com/job/full-time-permanent-hampshire-ref/ Veterinary Surgeon – Full or Part Time – South Yorkshire – Ref: 11123 This growing, established practice on the outskirts of the vibrant, cultural city of Sheffield is now offering a fantastic opportunity for a Veterinary Surgeon to join the team.
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3 vets, 1 RVN & 3 student VNs on the team. 15 minute appointments, or 30 minutes for more complicated cases. If you’re looking for a full-time role, you will work a 40-hour week over a 4 day rota including weekends, with no OOH responsibilities at all. However, they would also consider part time for the right candidate. Excellent package that includes a competitive salary, contributory pension, paid professional subscriptions and exclusive company discounts and rewards. An interest in orthopaedic surgery would work well, but this most definitely isn’t essential!
Click to find out more: http://www.jhprecruitment-veterinary.com/job/ veterinary-surgeon-full-or-part-time-12/ Full Time Veterinary Surgeon – Stirlingshire – Ref 13418 This friendly practice in Stirlingshire is looking for another experienced vet to join their team. The practice is well equipped and would welcome someone with an interest or specialism. They are looking to build on current successes, progressing together and offer their clients the best service possible. The practice encourages building your own client caseload and following your cases through. Both part-time and full-time opportunities are available as they are looking to expand the staff levels with salaries to match experience and the role. There are no OOHs and only 1 Saturday in 4, from 9am-12pm. CPD is encouraged and funded, and they offer exclusive company discounts, reward schemes and career development. Find out more here: http://www. jhprecruitment-veterinary.com/job/full-time-veterinary-surgeon-stirlingshireref/
Veterinary Surgeon – Full Time – Permanent – Surrey – Ref 11296 Based in Surrey,this practice is looking for an experienced surgeon to join them. Join a thriving team in a state-of-the-art, fully equipped, spacious, purposebuilt clinic where you’ll have the opportunity to develop your clinical skills with the benefit of an interesting and diverse caseload. You will have the support of a fantastic, forward-thinking team while working for a company with strong values. The practice truly care about all of the team, the people and pets they look after. You will be supported to develop your skills and will have the opportunity to progress within the business. Find out more about this opportunity: http://www.jhprecruitment-veterinary. com/job/veterinary-surgeon-full-time-permanent-21/ Veterinary Surgeon – Full Time – Permanent – South Wales – Ref 10819 This practice is looking for an experienced permanent veterinary surgeon to join their busy team. They are a very busy small animal (few exotics) practice, located in the South Wales valleys. They have 2 branches. The rota is 40 hours per week, which includes some Saturdays. Their core hours are 8.45am – 6.00pm weekdays and 8.45am – 12.00pm Saturday mornings. There is no sole charge or OOH. Salary will be dependent on experience and is very competitive. Apply now: http://www.jhprecruitment-veterinary.com/job/veterinary-surgeon-full-timepermanent-20/
WE W EA ARE RE IR HIRING! H R ING!
PFMA delighted with positive member feedback
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New survey taken by PFMA members confirms reasons why pet food manufacturers value the trade body.
ew survey taken by PFMA members confirms reasons why pet food manufacturers value the trade body. An impressive 100% confirmed the effectiveness of PFMA as overarching industry representative. The most valuable benefits of membership were ranked as: · Technical support 94% · Increased credibility 92% · Committees and Working Groups 85% · Lobby Influence 83% · Networking 81% · Educational Material 79% Deputy Chief Executive, Nicole Paley, responds to this feedback: “PFMA represents over 90% of the UK pet food industry with 85 companies in membership. Over the last 15 years, PFMA membership has doubled and diversified - we now have dedicated working groups focusing on feed for birds, fish and a group of commercial raw producers.” Nicole continues: “With this growth and diversification, we are delighted to have received such positive feedback after an extremely busy year. As a small team, we have had to balance our increased focus on Brexit with ‘business as usual’ so it’s testimony to the hard work of the team and the ongoing commitment of our members that our technical support, ongoing working groups and educational material has been so highly valued.” To find out more about PFMA, membership and nutrition advice, please visit pfma.org.uk or contact the team at info@pfma.org.uk / Nicole@pfma.org.uk.
It’s a bright cold day in April and the clock is striking one. At the foot of Brighton’s iconic clock tower a small table is being erected. Frenzied Sunday shoppers scurry past. Bleary-eyed party-goers stumble unknowingly through our make-shift consulting room.The soup is ready, and the stethoscopes are out.This is StreetVet. Almost immediately the bags are down, the owners and their dogs appear: strategically prompt for the acquisition of hot food, human necessities and to tend to the various niggles of thesefurry companions. And of course, they are companions so much more than they are pets. It surprises me how well cared-for the dogs are, how nurturing the owners are and how willing they are to undertake the treatments that we suggest. New owners and their dogsapproach us with anxiety and trepidation. To them this is a big deal. We offer food, treats, a smile and our time,well before we even start to get down to the nitty-gritty of veterinary medicine. StreetVet is not a quick fix, buta small, critical part of a multimodal treatment approach to the homeless
epidemic. We are privileged to be able to offer support from a very unique angle. We treat the acute issue, but more importantly we can impact the wider situation: providing preventative healthcare and empowering owners to take control of their situation, educating hostels in safe and effective housing of people with pets, helping owners who have neglected their own urgent medical care for fear of losing their pet, supporting those with assistance animals and providing an opening to a dialogue that may never have occurred had we not been there. The list goes on. The dogs draw the attention of the homeless community, they bring a warmth, people come over to ask if they can pet and feed them. These dogs are an integral part of the homeless scene and are often recognised and greeted before their owners. They create a sense of identity and purpose. The general public stop to chat and suddenly the cloak of invisibility is lifted. We are approached by a smartly dressed, softly spoken lady and her two elderly dogs who she acquired some eight years before she was
made homeless. She tells us how she, ironically, once ran a food bank for those in need. She describes her darker days and the lengths she went to, to ensure her dogs would not be euthanised. Pets are natural antidepressants and she is testament to this. She wants to talk, and she wants her message to be heard: “…this can happen to anyone”. We set about the task in hand. Wormers are given, microchips scanned, coats measured up and fitted, ears examined, and medicated, anal glands expressed, castration wounds checked, worries listened to and concerns abated. People take very little from us; in most cases just enough to fill a pocket or to fit into a small bag. The crowds start to dwindle. Notes made, bags packed, we disperse into the Sunday shoppers. StreetVet currently has outreach schemes in 12 cities across the UK run by volunteer vets and vet nurses. We always welcome new volunteers. For more information on StreetVet and what we do, or to contact us, please visit our website: www.streetvet.co.uk, or find us on Facebook, Twitter or Instagram.
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’ve recently been back in clinic and chatting with a colleague about missing being a clinical coach. We shared some lovely positive stories of students we had helped and gave each other that little rosy glow you get when assisting others to achieve their dream of becoming a vet nurse. It got me thinking about the different people who input into our vet and vet nurse training and the differences with the two approaches to ‘on the job’ learning. I’ve not seen this as much of an issue in the EMS scheme but my experience of that was based on students being in theatre for much of their time, rather than in consults, so perhaps I’ve just missed this happening. The ‘this’ I’m referring to is the issue I’ve sometimes noted of people using training others to create ‘Mini Me’s’ of themselves. Not just in terms of clinical skills but in approaches to patients, colleagues and clients too. I often see people judging a student’s progress from their own view point and miss that a ‘good student’ isn’t the one that is the most like them in personality but the one who is working hard to improve their skills and meet the criteria to pass their course. There is space for everyone It’s really important to remember this even as spaces on courses rise, we don’t want to be simply generating more Mini Me’s in different places. Both vet and vet nurse courses aren’t assessed on personality, they are assessed on skills and competency. The vet and vet nurse courses both have Day One skills as a focus – if students meet the criteria of the course they undertake then they can complete Day One skills and
can enter the RCVS register. Not every student has to be the same or a mirror image of the people that trained them. Just because you learnt in one way or one environment doesn’t mean to say you have to work in the same environment and teach in the same way. To be a successful educator you need to understand what you are teaching so it can be applied in different teams/clinics/patients. Teaching in this way creates a student who doesn’t just mimic their educators but gets them to think about the context of their learning. Adjustable leadership is required to see beyond your own knowledge, experience and filters and not judge what a student offers against your own personal ways. I recall once overhearing a student give safety advice on the use of a spray-on flea treatment. Her words to the clients were “When you use this, don’t have a fag, ‘cause you’ll go WHOOSH!” Not the words I would have chosen, but exactly right for the clients - who immediately were engaged with her and knew what she meant. The student chose the right words for her, the client and the situation. A definite winner on the communication front (if a little unorthodox) but not every client knows what ‘volatile’ or ‘highly flammable’ means with regard to a lit cigarette. A bigger issue? I’ve also had this thought at the back of my mind for a while… is one of our issues in recruiting for vet and vet nurse courses that many of us are looking for that ‘Mini-Me’? Someone just like us, because clearly we’re doing well as we’ve already passed the course.
Jane’s Blog Does this mean we don’t take into account that the skills and ability needed to pass the course? Being a great team member of the profession will be different and appear differently in everyone. I’m not sure, but the personality types of many vet students are very similar. Is there any way to distinguish between those we attract to the industry and those we identify with and admit, compared to those who are attracted to the industry and don’t get in? I’m not sure, and there isn’t just a single answer to the recruitment and retention issue, but I do know that creating an army of ‘Mini Me’s’ isn’t giving your students the skills to be the best student they can be,nor is it the answer to our staffing crisis. Take me, for example, do we need any more brachy-obsessed nurses with bad backs? Really?
WEBINAR GENERAL APPROACH TO THE POISONED PATIENT LINDSAY KELLET GREGORY BSc. B.VET MED DACVECC DECVECC FHEA MRCVS RCVS SPECIALIST DICK WHITE REFERRALS
David’s Review
In the webinar itself, here is an outline of what to expect: •
Major body Systems examination
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Immediate life saving measures
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Emergency database
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Minimise further systemic poison absorption
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Administer antidote if available
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Promote elimination of poison already absorbed
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Further clinical evaluation as appropriate
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Symptomatic, supportive and nursing care
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Close monitoring and regular repeat clinical examinations.
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t’s hard to imagine anyone better qualified to deliver this series of veterinary webinars on canine and feline toxicology than Lindsay. She has honours BSc and BVetMed degrees with dual American and European diplomate status in Emergency and Critical Care. This is the first of four webinars in a series that promises to get you to the highest level in dealing with poisoned patients. There is a brief introduction before Lindsay’s contribution. This by the TVM company, generous sponsors of the webinar. They have the following licensed products of use in toxicology -apomorphine(Emedog), activated charcoal(Carbodote), Vitamin K1, and diazepam (Ziapam). These products come with advisory literature and dosage regimes. Often the emergency poisoning case begins with a call to the practice. There is a useful section here, particularly to nurses/receptionists, on what to ask of the client, aiming to establish the severity of the potential exposure. In particular is the exposure • • •
Clinically significant? Potentially toxic Potentially fatal?
Another useful table lists the top ten common poison enquiries to the VPIS in dogs and cats in the latest (2017) data.
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NSAIDs-particularly Ibuprofen Anticoagulant rodenticides Chocolate Paracetamol Permethrin-in cats Metaldehyde Lilies-in cats Grapes, raisins, sultanas and currants Adder envenomation Benzalkonium chloride
How about this for an astonishing statistic? The VPIS 2017 report states that ‘the 11,648 enquiries received in 2017 involved 16,390 agents’ Useful websites are given to help navigate through this. They are: www.tvm-uk.com Sponsors of the webinar with relevant licensed products www.vpisglobal.com The Veterinary Poisons Information Service (VPIS) for vets www.animalpoisononline.co.uk Animal poison line for owners. This organisation also offers 24 hours advice for owners on 01202 509000(mainly a triage service). A further important resource for toxicology cases is ‘ToxBox’ accessed via VPIS. This is an emergency kit containing all available antidotes and products. There is a list of
practices that maintain a ToxBox and rarely-used drugs can be accessed from one of these in an emergency. There are a few pieces of advice for home management, although this is only recommended if 100% sure the exposure was non-toxic. Otherwise the poisoning case needs to be brought to the practice. The next slides detail further history, emergency assessment (Airway, Breathing, Circulation), and major body assessments of the respiratory system, nervous system and cardiovascular system in particular, followed by stabilisation measures. While this is being enacted a more detailed history can be taken to establish the exact poison if known, when it was ingested and quantity involved, which will enable a consideration of what might happen. For this, the clinician will want to know how quickly the poison is absorbed, its LD50, the mechanism of action and adverse effects, how it is absorbed,
whether it is acidic or alkalotic (a consideration affecting the decision to induce emesis) and finally whether it binds to charcoal. There is a brief overview on decontamination of the patient and antidotes, including also the promotion of elimination of absorbed poison by diuresis and also by intravenous lipid emulsion. These subjects will be dealt with in much more detail in subsequent webinars. The final scientific part of this webinar covers the evaluation of the intoxicated patient using routine blood testing and serum biochemistry, urinalysis, ionised calcium measurement and patient side testing for ethylene glycol levels. A couple more useful websites are given at the end. For specific toxicology testing there is The Veterinary Pathology Group (VPG Leeds) www.thevpg.co.uk
This laboratory has a typical turnaround of 3-5 days (but next day results for some panels may be available). Extensive toxicology testing is available including drugs of abuse, anticoagulant rodenticides, metaldehyde etc., although the accuracy of the results will depend on the timing of exposure and the samples submitted. In summary this webinar is an excellent start to the four-webinar series. Lindsay has a wealth of knowledge and experience, which she delivers effortlessly. I particularly liked the recommended websites and there is a final one from Vets Now on how to calculate whether a particular episode of chocolate ingestion is likely to be toxic or not. www.vets-now.com/dog-chocolatetoxicity-calculator Involvement of the entire practice team is recommended and therefore one for everyone to watch.
WEBINAR PROMOTING A HEALTHY GUT-BRAIN AXIS IN ANIMALS FRANCESCA GAZZANIGA PHD POST DOCTORAL FELLOW AT HARVARD MEDICAL SCHOOL WYSS INSTITUTE FOR BIOLOGICAL INSPIRED ENGINEERING
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urina generously sponsored this veterinary webinar and it really is cutting edge, with new discoveries occurring all the time. The speaker has an amazing CV (worth looking up) and explains some quite complex studies in a way that never loses your attention. Much of the work described here is generated by investigation into human conditions, but as the solutions to the diseases involve the use of probiotics there is plenty of scope for involvement in the veterinary field in the near future. The title is specifically involving the gut-brain axis and Francesca begins by a comprehensive list of human neurological diseases currently under investigation. Astonishingly there are 100 trillion bacteria that live in the human gut that are postulated to influence neurological diseases. Those that can be affected in this way include:
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Multiple sclerosis Autism Parkinson’s disease Alzheimer’s disease Depression and mood disorders Viral encephalitis Stroke Epilepsy
The way in which bacteria influence the brain is explained succinctly in a line diagram showing that microbial metabolites enter the blood stream and stimulate specific cell types. Bacteria can also affect immune cells in diseases such as autism and multiple sclerosis. There are human models and mice models that can be used
in research. Much of that undertaken by Francesca and colleagues is with mice, and in particular germ-free mice delivered by caesarean section in special isolators. Preliminary invitro studies are also undertaken in specially designed microfluidic gut chips. The germ-free mice can be individually given specific bacteria so that their unique effect can be studied. The aim is to compare gut bacteria in symptomatic versus healthy mice to identify prohealth bacteria. We are taken through a study investigating gut microbiota effects on social behaviour in mice. There is a difference between the offspring of maternal obese mice (made so by a high fat diet) and those from normal mothers. Mice from obese mothers have a different microbiota and they exhibit social deficits (described here as autistic-like) but adding lactobacillus reuteri ‘rescues’ this social deficit. The study is ingenious and thought-provoking. Similar studies demonstrated that maternal infection during pregnancy increases the risk of autism-like behaviours and oral bacteroides fragilis can rescue some autism-like symptoms. The autism-like symptoms are described as: Decreased
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Communication Open field exploration Sociability
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Repetitive behaviour Leaky gut Gut dysbiosis
There is a brief discussion on how immune signalling can mediate the gut brain axis in autism models via the oral administration of B. fragilis, principally by blocking IL17. Similar studies are looking at certain bacteria that seem to exacerbate Parkinson’s symptoms. We are introduced to concepts and possibilities of applying this new knowledge to veterinary medicine. In companion animals, for example, high-fibre diets promote bacteria that produce shortchain fatty acids that may protect from intestinal infections, models of colitis and asthma. Of even more interest, perhaps, is that a ketogenic diet can offer protection from and reduce seizures in human and mouse models. In this diet Akkermansiamuciniphilaand Parabacteroides are increased in the microbiota and are the reason for a reduction of seizures. Furthermore, supplementing with these bacteria in mouse models confers protection
WEBINAR IMPORTED INFECTIONS… IT CAN HAPPEN TO YOU IAN RAMSEY SMALL ANIMAL HOSPITAL DIVISION OF COMPANION ANIMAL STUDIES UNIVERSITY OF GLASGOW VETERINARY SCHOOL
from seizures. Studies are underway to see whether similar supplements can protect animals from seizures. This leads onto a discussion of how to make a good probiotic, step by step, and ends with a glimpse into the future. This will involve testing companion animal faecal samples in mice and in invitro chips. At present many cat and dog microbes are unknown. This fascinating webinar takes us into an exciting field of research and will probably revolutionise the way we view many diseases in the future. We can also expect new probiotic diets to treat disease. I would be willing to bet there will be some Nobel prizes awarded for future discoveries particularly if they lead to alleviation of some of the seemingly intractable neurological diseases discussed here. This is a thoroughly recommended webinar. It’s not often you get the opportunity to listen to a world expert from human research, in an area that is rapidly gaining in importance. You can sense that Francesca really loves her subject and speaks clearly in an uncluttered way. She comes from a highly respected academic family as does her husband, also a PhD researcher. She is still only 34 years old and I wonder what achievements lie ahead over the coming years!
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his is a timely veterinary webinar during the Brexit (sorry to mention it) saga. There are huge numbers of dogs being imported to the UK under the Pets Scheme-I will leave you to work the figure out, and with this huge number risks of importing diseases. Ian begins by outlining details of a dog imported from Romania a few years ago and just recently seen in the University clinic in Glasgow. Details in the webinar but it can, as the title suggests, happen to you. There is some justified criticism of the abandonment of testing introduced in 2012 with some unforeseen consequences described. Ian gives a list of possible imported diseases but concentrates on four beginning with Rabies.
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e feels that vets should view an old video of a case of human rabies to remind themselves of its horrors and it is not for the faint hearted. I have copied the relevant website here: www.youtube.com/watch?v=moG6JDmJdc There follows a succinct summary of rabies, mentioning the various strains worldwide including in bats. A diagram illustrates the pathogenesis of the disease followed by a list of signs under the headings: • • • •
Encephalitic (furious) vs. Paralytic (dumb) forms Behavioural Changes Cranial nerves Peripheral nerves
Rather worryingly for colleagues not familiar with clinical cases is that there is a very extensive list of differential diagnoses for the possible signs and rabies could easily be missed. In cats the furious form is more prominent (also worrying for different reasons). The most likely route of entry into the UK is via smuggling. Dogs are the most likely animals and the most likely person to identify a case is a local veterinary surgeon. There is a summary of some recent cases in France in animals, all of which had been illegally imported dogs or cats. Advice is given on what to do if you suspect rabies. Essentially contact the local DVO office (or police –but they are unlikely to know what to do). Specifically, do not refer the animal, euthanise it or (clearly) handle it! What then should happen is advice from consultants in communicable disease control, with the animal observed and investigated. Further advice is given on first aid measures following a bite. European bat lyssavirus occurs in the UK and there was a fatality in a bat worker in Scotland in 2002 and some species of bats have 5% seroconversion rates. Thus, rabies is in fact in the UK although bat disease is rare and very rarely causes disease in humans. Vets
who may be asked to look at bats need to be aware of the risks.
short duration low dose prednisolone is the recommended treatment.
Leishmaniasis is by contrast a disease that colleagues are increasingly aware of. It is widespread in Europe and a map illustrates this well. Caused by Leishmania infantum it is particularly common in Spain, Portugal, southern France and Italy.
Babesiosis- another tick-transmitted disease is described next. There are several species involved, mainly Babesia canis and less commonly Babesiagibsoni, with Dermacentor reticularis and Rhipicephalus sanguineus being the ticks responsible for transmission. Clinical signs are listed under non-specific, haemolytic anaemia, shock, DIC and death.
Transmitted by sand flies in woodlands and beaches, with direct transmission dog-to-dog and dog-to-human being possible, particularly in individuals that are immunocompromised for whatever reason. There is a very good summary of signs in this waxing and waning disease including serious systemic signs, dermatological signs and others such as panophthalmitis, shifting lameness and anaemia. There are some good clinical pictures with a list of differentials-these are extensive. Diagnosis is well covered and treatment options are discussed. In contrast to statements from certain rescue charities, treatment is not straightforward, rarely results in a cure and is often very costly. Prevention is better than cure and measures to achieve this are summarised –but personally I wouldn’t want to risk taking any dog of mine to an endemic area. As an aside, it is interesting to hear that the ophthalmologists in Glasgow get substantial numbers of cases referred to them. Ehrlichiosis/Anaplasmosis is in Ian’s top four and is caused by Rickettsia genera, and several species are described. They are tick transmitted and the major tick concerned is Rhipicephalus sanguineus. Acute and chronic signs are listed with some excellent illustrations of pathological specimens. Ian points out, while thanking his colleagues for providing the material, and that the illustrations represent ‘career best’ - not always so easy in practice! Diagnosis by haematology, direct observation, serology and PCR are all described. Treatment with Doxycycline along with
Diagnosis and treatment are well described. We are advised not to forget fungal diseases and parasitic diseases and Ian ends with another recent case from Romania of a dog with Brucellosis, which had to be euthanised. A very simple message that comes through in this webinar is to always ask about foreign travel either with the animal in question or with in contacts. Worryingly there have been cases of leishmaniasis with no known foreign contacts. Perhaps in the near future this disease, due to climate change, could become endemic with sand flies establishing themselves. This is a very good summary of the main imported infectious diseases to be concerned about. It is an excellent account of the main clinical features of the four diseases discussed. This webinar is thoroughly recommended and one for the entire practice team to watch-except maybe the tragic case of the rabies victim. It is a timely warning, though, that things will have to change if we want to prevent the disease, and others so well described in the webinar, from arriving in the UK.
WEBINAR CHRONIC DIARRHOEA: A RATIONAL APPROACH TO INVESTIGATION JAMES MCMURROUGH BVSC CERTAVP (SAM) CERTAVP (VC) MRCVS RCVS ADVANCED PRACTITIONER IN SMALL ANIMAL MEDICINE AND VETERINARY CARDIOLOGY
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his webinar is one aimed at first opinion practitioners and offers a logical approach to the common problem of chronic diarrhoea, defined as being present for more than 3 weeks, and having failed to respond to symptomatic therapy. To define the problem, it is necessary to determine whether it is primarily small bowel or large bowel diarrhoea or mixed. Before answering that question, we are introduced to a couple of indices to quantify the problem. The first of these is the Canine Inflammatory Bowel Index Score (CIBDA), which is used to quantify the severity of IBD. Scores are allocated at presentation and following treatment. A tablegives a straightforward means of allocating this score in a range from clinically insignificant disease to severe IBD. Another scoring system is the CECCAI, which includes scoring for albumin, ascites and peripheral oedema and is more powerful in predicting an outcome. Another comprehensive table lists the primary and secondary causes of chronic diarrhoea-this would be very useful when investigating these diseases to have to hand. A recent article yields valuable information based on 136 cases of chronic diarrhoea in dogs. Of importance is that 90% of dogs had a primary enteropathy and 66% of these were dietary responsive, 23% idiopathic, 13% infectious, 11% antibiotic responsive and only 4% neoplastic. Exocrine pancreatic disease was the most common disease in the 10% of dogs with secondary problems. Encouragingly of these 136 dogs 87% had a clinical remission with 13% dying or not responding to treatment.
With this background information we are now introduced to James’ systematic approach involving 6 steps: 1. History and physical examination 2. Rule out and treat endoparasites 3. Differentiate primary from secondary causes of diarrhoea 4. Characterise the disease process 5. Therapeutic trial (if not contraindicated) 6. Histopathological examination of gastrointestinal biopsies The webinar takes us through these six steps in some detail, and with each step even experienced colleagues will certainly pick up useful tips. Just as with dermatological cases the importance of a thorough history is often overlooked, and several slides emphasise this. Another useful table outlines the differences between small intestinal and large intestinal disease alluded to at the beginning of the webinar. Although the physical examination may be unrewarding the body condition score is useful, along with abdominal palpation. Endoparasites and bacterial causes are comprehensively discussed both in diagnosis and treatment before moving on the use of biochemistry and haematology to help exclude extragastrointestinal disease. This includes a full discussion of PLI, TLI, Folate and Cobalamin, C-reactive protein, basal cortisol and bile acids. Radiography is of little to no use in chronic diarrhoea cases, but ultrasonography in the hands of a skilled operator with suitable equipment has a
moderate use in just over a third of cases, based on one article cited. Half a dozen high quality images of ultrasound show examples of where the procedure had diagnostic value. Having got this far we are left with just four conditions in the majority of cases. These are, with alternative names in brackets: • • • •
Dietary responsive enteropathy (dietary allergy/intolerance) Antibiotic responsive enteropathy (ARD, dysbiosis) Fibre-responsive enteropathy (fibre-responsive colitis) Steroid responsive enteropathy (IBD)
Other more rare conditions include lymphangiectasia and lymphoma for example. Trial treatments with first diet and then antibiotics are performed at this stage, leaving the more expensive testing to last. How to conduct these trials and how they can in fact be done together to save time and expense is well explained. The final part of the webinar has some detail on biopsy techniques and ends with a consideration of immunosuppressive therapy and additional therapies such as probiotics. A flow chart nicely summarises the investigative approach in the last slide. This webinar is pitched at first opinion colleagues, although everyone, including residents will find lots of information points too. Above all, as I have mentioned already, it is extremely logical. It is hard to imagine that many such cases would need referral if the approach was followed-and that 87% success rate quoted would surely encourage you!
From the Literature –May’19
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expect the vast majority of colleagues reading this will be BVA members and therefore receive the veterinary record and the excellent In Practice journal. Perhaps you missed some of the articles below or haven’t had time yet to read them, so I am flagging them now. There are some interesting and useful articles in the latest (April 2019) edition of In Practice. It’s quite a mixture with a detailed article from Sue Murphy, currently director of clinics at the Edinburgh school, on how to give clients a more accurate oncology prognosis. She gives, in box form, the jargon used by oncologists, followed by a consideration of cutaneous mast cell tumour and soft tissue sarcomas in particular.
The article covers very good summaries of grading, cell proliferation markers for prognosis and staging. Finally, there is some information on the usefulness or otherwise of haematology and biochemistry. Also, in this edition is an article by James Grierson on decisionmaking in dealing with pelvic fractures in cats, which will interest orthopaedic specialists and those in training. Elisabetta Mancinelli comprehensively covers respiratory disease in rabbits, with no less than 18 high quality illustrations of cases, radiographs and CT scans. This is a definitive account of the subject. Of greatest interest personally, was a consideration on the use of allergy tests in practice.
Using ‘allergy tests’ in cases of canine dermatitis In Practice April 2019 Volume 41 No3pages 115-120 Aiden Foster
Aiden is a Bristol graduate (1987), achieving the Dip ACVD in 1998 and is currently a senior teaching fellow at the Bristol Veterinary School. In this article he seeks to de-mystify the confusion surrounding the diagnosis of allergic skin conditions in dogs. In the abstract he states that with the access to a variety of commercial serological tests measuring IgE, and sometimes IgG, there is a great potential to misuse them and for wasting clients’ money. Thus, as has been stated many times in recent veterinary literature, serological tests and intradermal tests are not definitive diagnostic tests and are
therefore not required for this purpose. Atopic dermatitis is diagnosed on the basis of an appropriate history, clinical signs, rule out of ectoparasites, a consideration of the role of cutaneous microbial infections and assessing for flea, food and contact allergies. If this seems daunting to primary care practitioners a very good box summary of how to approach canine atopic dermatitis follows. Right at the end of the process is whether to consider allergen immunotherapy if intradermal tests and/or serological tests are clinically relevant. This box summary is worth printing out to
constitute a possible practice policy for dealing with allergic skin disease in the dog. The allergy tests only become cost effective once a case has been thoroughly investigated and the disease pattern established. A table lists the components of a specific allergen serologic test noting that there are some difficulties resulting from lack of calibration and evaluation, and it is not possible to readily compare results from different laboratories due to the use of different antigen extracts. Another table lists the types of allergens and adds relevant comments. Those listed are:
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Fleas Food Malassezia species Mites Pollens Moulds Sarcoptesscabiei
The evidence or otherwise for the usefulness of the above testing is well summarised. Most dogs in the UK demonstrate perennial signs due to house dust and storage mite allergens, which are ubiquitous. A few dogs with seasonal disease may only test positive to pollen. But common sense advice suggests that testing for such dogs may not be a prudent use of owner resources as it may be more cost effective to manage the pruritus with other therapies during the season of disease. The thorny question of when to stop steroids is tackled. One of the proposed advantages of serological testing is that steroids do not have to be stopped before a sample is taken. However, there is limited data available to support this statement and Aiden uses the same washout periods whether he is testing serologically or by intradermal testing. There is more common sense advice when discussing immunotherapy. Aiden avoids parroting what many others have said about the success rate of this form of therapy. Instead of the usual 50-80% success rate he states that the success rate is extremely variable, and it is (my italics) likely that many clinicians and owners abandon this approach at an early stage…. Advice is given on owner communication and it is critical to choose clients very carefully for immunotherapy because when it is successful it can be a very cost-effective and safe means of controlling the signs of atopic dermatitis.
The difficulties of allergen avoidance are clearly outlined, with most method to attempt this failing, but the key point is that allergen avoidance is still worth pursuing, although on its own is unlikely to make an atopic dog substantially better. This excellent article is supplemented with 9 high quality clinical presentation pictures that will be very helpful to first opinion practitioners. This is by far the best I have read on this subject and fulfils its aim, which is to provide an overview of how allergy tests can be used to help the diagnosis and treatment of allergic skin diseases in dogs. It is written in a clear educational way and is written for the non-specialist, although many specialists will learn from the article, not least because it contains genuine original thought based on available evidence. Staying on this disease, the search for a complete understanding of atopy fills many journals. The above article in many ways is a good start because it enables colleagues new to the discipline to avoid some common mistakes in diagnosis. For those wanting to know more you need look no further than the latest edition of Veterinary Dermatology –Volume 30 Number 2 April 2019. You can get this superb dermatology journal by joining the ESVD at very reasonable rates. The reduction in the annual congress fees for members matches the joining fee. While I am on the subject of congresses, the next ESVD congress is in Liverpool from the 26th- 28th of September 2019. Next year the world congress will be in Sydney from the 20th24th of October. In this latest edition of Vet Derm there is an editorial from Thierry Olivry and FraneBanovic on whether it is time to revise the strategy of canine atopic dermatitis treatment. There is plenty that follows to delight the academics on the latest research into atopy. There are articles on: -
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The pharmacodynamics of antihistamines, The use of a monoclonal antibody blocking a single cytokine to prevent allergy flares, An exposure of direct to consumer hair and saliva tests for pet allergies -being no better than chance, Efficacy of oclatinib in feline pruritus, Measurement of serum macrophage migration inhibitory factor in atopy, Studies on skin barrier function, A fascinating study into the effect of the microbiome in atopic dogs,
• Several articles on otitis externa, an article on equine Culicoideshypersensitivity, new prognostic markers for cutaneous mast cell tumours and other tumour related contributions • An interesting article on a new treatment for lice in peacocks -from Mexico
Plenty here to get your teeth into! And tucked away right at the end of the journal a very useful mini article on dermatophytosis in cats by Karen Morielloarguably the world expert on this disease. Here she gives recommendations on decontamination of homes exposed to feline ringworm.
Decontamination of 70 foster homes exposed to Microsporumcanis infected cats: a retrospective study Karen A Moriello | VetDermatol 2019 178-179
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aren states that the risk of contracting small animal dermatophytosis from the environment is low, although environmental contamination is a worry. Owners always ask, ‘how do I know it is out of my house?’ This article answers the question. Over a ten-year period 70 foster family homes were identified where dermatophytosis cats had lived. Mechanical debris was removed from rooms, the areas cleaned with over the counter household detergents and hard surfaces
disinfected with 1:100 concentration of household bleach or accelerated household detergents. Of the 70 homes 69 were successfully decontaminated, many with just one decontamination process, and some needing one or two more. Only one home, where compliance was poor, could not be successfully decontaminated. This is a very relevant study particularly for those dealing with homing centres and rescue organisations.
Karen has written before on this subject and I add two articles for colleagues who want to follow up in more detail: Moriello KA. Decontamination of carpet exposed to Microsporumcanishairs and spores. J Feline Med Surg 2017 19 435-439 Moriello KA, Decontamination of laundry exposed to Microsporumcanishairs and spores J Feline Med Surg 2016 18 457-461